AB0344 EFFICACY AND SAFETY OF NINTEDANIB IN INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS: A SINGLE CENTER 6 MONTHS OBSERVATIONAL STUDY
Authors: O. Murata, T. Okawara, M. Fujimoto, T. Naka
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Nintedanib, an intracellular inhibitor of tyrosine kinases, inhibits processes involved in the progression of lung fibrosis [1]. Although the efficacy and safety of nintedanib have been demonstrated for interstitial lung disease (ILD) associated with systemic scleroderma (SSc) [2-4], information of the efficacy and safety of nintedanib in patients with rheumatoid arthritis (RA) is limited [5]. <h3>Objectives</h3> The aim of this study was to compare the efficacy and safety of nintedanib in patients with RA-ILD with those in patients with ILD associated with collagen tissue diseases, including SSc-ILD. <h3>Methods</h3> We extracted patients who visited our department and were received nintedanib and had pulmonary function tests performed 6 months after. Then, they were divided into two groups, which were RA group and non-RA group. Clinical and epidemiological parameters, fibrosis pattern on HRCT, pulmonary function at the time of nintedanib administration and 6 months after nintedanib administration and adverse events were compared between the two groups. Those data were collected from medical records and statistically analyzed. <h3>Results</h3> Ten patients were enrolled. RA group had 6 patients and non-RA group had 5 patients. Among the RA and non-RA group, 50% and 60% were women, respectively (<i>P</i>=0.74). Age at the time of nintedanib administration was 70.8±5.5 years and 59.0±9.1 years, respectively (<i>P</i>=0.035). At the time of nintedanib administration, oral glucocorticoids (GC) were used in 83.3% and 100%, oral GC dose was 8.5±10.9 mg/day and 9.4±1.7 mg/day, and immunosuppressants were used in 83.3% and 100% (<i>P</i>=0.27, 0.17, and 0.27, respectively). Usual interstitial pneumonia (UIP) pattern on HRCT was 100% and 40%, and nonspecific interstitial pneumonia pattern on HRCT was 0% and 60%, respectively (<i>P</i>=0.013). At the time of nintedanib administration, FVC was -1977±867.2 ml and 1654±507.3 ml, %FVC was 66.9±20.7% and 53.2%±10.9%, and %DLco was 54.8±8.9% and 46.2%±15.9% (<i>P</i>=0.58, 0.36, and 0.51, respectively). After 6 months of nintedanib treatment, ΔFVC was -18.3±103.5 ml and -24.0±101.5ml (Figure 1.), Δ%FVC was 0.75±5.03% and -2.4%±1.91%, and Δ%DLco was 0.375±4.02% and -7.27%±6.54% (<i>P</i>=0.52, 0.20, and 0.28, respectively). The incidence of adverse events was 50% and 40%, respectively. In the both groups, there was no patients with severe adverse events and acute exacerbations of ILD, and the continuation rate was 100%, respectively. <h3>Conclusion</h3> This observational cohort study revealed that there was no statistically significant difference in the reduction of respiratory function in both FVC, %FVC, and %DLco in the RA group compared to the non-RA group, and the safety was also comparable between the two groups. Although RA-ILD have more UIP pattern on HRCT than SSc-ILD, nintedanib may effective for RA-ILD as same as SSc-ILD. <h3>References</h3> [1] Eur Respir J 2015;45:1434-45, [2] N Engl J Med 2019; 380 (26):2518-2528, [3] Lancet Respir Med 2021; 9:96-106, [4] Mod Rheumatol 2020 Apr 3:1-26, [5] Arthritis Rheumatol. 2022 Jun; 74(6):1039-1047. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.